Vagus nerve stimulation has been a therapy for epilepsy approved by the US Food and Drug Administration (FDA) for patients 4 and older and shown efficacy and safety in younger pediatric patients.
Methods:
The authors performed a retrospective analysis utilizing Medicaid claims from an accountable care organization to measure the intervention of vagus nerve stimulation therapy in regard to unplanned health care utilization. Thirteen unique patients were included who had vagus nerve stimulation therapy who had at least 6 months of continuous enrollment in a managed Medicaid health plan. Comparison with 12 months of data before and after vagus nerve stimulation implantation was performed.
Results:
Patients had statistically significant fewer unplanned inpatient visits per patient per enrollment month after vagus nerve stimulation implantation.
Conclusion:
Utilizing claims data, vagus nerve stimulation implantation demonstrates a reduction in unplanned hospitalizations.
CowanLDBodensteinerJBLevitonA. Prevalence of the epilepsies in children and adolescents. Epilepsia. 1989;30(1):94–106.
2.
LairsonDRBasuRBegleyCE. Concordance of survey and billing data in a study of outpatient healthcare cost and utilization among epilepsy patients. Epilepsy Res. 2009;87(1):59–69.
3.
BeghiEFrigeniBBeghiM. A review of the costs of managing childhood epilepsy. Pharmacoeconomics. 2005;23(1):27–45.
4.
BegleyCEAnnegersJFLairsonDR. Cost of epilepsy in the United States: a model based on incidence and prognosis. Epilepsia. 1994;35(6):1230–1243.
5.
BegleyCEFamulariMAnnegersJF. The cost of epilepsy in the United States: an estimate from population-based clinical and survey data. Epilepsia. 2000;41(3):342–351.
6.
OldhamMSHornPSTsevatJ. Costs and clinical outcomes of epilepsy surgery in children with drug-resistant epilepsy. Pediatr Neurol. 2015;53(3):216–220.
7.
WidjajaELiBSchinkelCD. Cost-effectiveness of pediatric epilepsy surgery compared to medical treatment in children with intractable epilepsy. Epilepsy Res. 2011;94(1-2):61–68.
8.
MoranNPooleKBellG. NHS services for epilepsy from the patient’s perspective: a survey of primary, secondary and tertiary care access throughout the UK. Seizure. 2000;9(8):559–565.
9.
SchachterSC. Vagus nerve stimulation therapy summary: five years after FDA approval. Neurology. 2002;59(6 suppl 4):S15–S20.
10.
DuganPDevinskyO. Epilepsy: guidelines on vagus nerve stimulation for epilepsy. Nat Rev Neurol. 2013;9(11):611–612.
11.
MorrisGL IIIGlossDBuchhalterJ. Evidence-based guideline update: vagus nerve stimulation for the treatment of epilepsy: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013;81(16):1453–1459.
BeniflaMRutkaJTLoganW. Vagal nerve stimulation for refractory epilepsy in children: indications and experience at the Hospital for Sick Children. Childs Nerv Syst. 2006;22(8):1018–1026.
14.
BuoniSMariottiniAPieriS. Vagus nerve stimulation for drug-resistant epilepsy in children and young adults. Brain Dev. 2004;26(3):158–163.
15.
ChenCYLeeHTChenCC. Short-term results of vagus nerve stimulation in pediatric patients with refractory epilepsy. Pediatr Neonatol. 2012;53(3):184–187.
16.
FanPCPengSSYenRF. Neuroimaging and electroencephalographic changes after vagus nerve stimulation in a boy with medically intractable myoclonic astatic epilepsy. J Formos Med Assoc. 2014;113(4):258–263.
17.
FernandezLGedelaSTamberM. Vagus nerve stimulation in children less than 3 years with medically intractable epilepsy. Epilepsy Res. 2015;112:37–42.
18.
HallbookTLundgrenJStjernqvistK. Vagus nerve stimulation in 15 children with therapy resistant epilepsy; its impact on cognition, quality of life, behaviour and mood. Seizure. 2005;14(7):504–513.
LundgrenJAmarkPBlennowG. Vagus nerve stimulation in 16 children with refractory epilepsy. Epilepsia. 1998;39(8):809–813.
21.
NamgungWCKoTSLeeSA. Vagus nerve stimulation for intractable epilepsy: outcomes in children and adults. Neuromodulation. 2010;13(1):44–49.
22.
OroszIMcCormickDZamponiN. Vagus nerve stimulation for drug-resistant epilepsy: a European long-term study up to 24 months in 347 children. Epilepsia. 2014;55(10):1576–1584.
RossignolELortieAThomasT. Vagus nerve stimulation in pediatric epileptic syndromes. Seizure. 2009;18(1):34–37.
25.
SerdarogluAArhanEKurtG. Long term effect of vagus nerve stimulation in pediatric intractable epilepsy: an extended follow-up. Childs Nerv Syst. 2016;32(4):641–646.
26.
ShermanEMConnollyMBSlickDJ. Quality of life and seizure outcome after vagus nerve stimulation in children with intractable epilepsy. J Child Neurol. 2008;23(9):991–998.
27.
TerraVCFurlanettiLLNunesAA. Vagus nerve stimulation in pediatric patients: is it really worthwhile?Epilepsy Behav. 2014;31:329–333.
28.
TsaiJDChangYCLinLC. The neuropsychological outcome of pediatric patients with refractory epilepsy treated with VNS—a 24-month follow-up in Taiwan. Epilepsy Behav. 2016;56:95–98.
29.
YuCRamgopalSLibensonM. Outcomes of vagal nerve stimulation in a pediatric population: a single center experience. Seizure. 2014;23(2):105–111.
30.
AburahmaSKAlzoubiFQHammouriHM. Vagus nerve stimulation therapy in a developing country: a long term follow up study and cost utility analysis. Seizure. 2015;25:167–172.
31.
Ben-MenachemEHellstromKVerstappenD. Analysis of direct hospital costs before and 18 months after treatment with vagus nerve stimulation therapy in 43 patients. Neurology. 2002;59(6 suppl 4):S44–S47.
32.
CampCSmithsonWHBunkerM. Impact of vagus nerve stimulation on secondary care burden in children and adults with epilepsy: review of routinely collected hospital data in England. Epilepsy Behav. 2015;52(pt A):68–73.
33.
HelmersSLDuhMSGuerinA. Clinical and economic impact of vagus nerve stimulation therapy in patients with drug-resistant epilepsy. Epilepsy Behav. 2011;22(2):370–375.
34.
KalanithiPSArrigoRTTranP. Rehospitalization and emergency department use rates before and after vagus nerve stimulation for epilepsy: use of state databases to provide longitudinal data across multiple clinical settings. Neuromodulation. 2014;17(1):60–64; discussion 64-65.
35.
KelleherKJCooperJDeansK. Cost saving and quality of care in a pediatric accountable care organization. Pediatrics. 2015;135(3):e582–589.
36.
JetteNReidAYQuanH. How accurate is ICD coding for epilepsy?Epilepsia. 2010;51(1):62–69.
37.
WijnenBFvan MastrigtGAEversSM. A systematic review of economic evaluations of treatments for patients with epilepsy. Epilepsia. 2017;58(5):706–726
.
38.
CohenLJAllenJCJr. Estimating the potential savings with vagus nerve stimulation for treatment-resistant depression: a payer perspective. Curr Med Res Opin. 2008;24(8):2203–2217.
39.
HelmersSLDuhMSGuerinA. Clinical outcomes, quality of life, and costs associated with implantation of vagus nerve stimulation therapy in pediatric patients with drug-resistant epilepsy. Eur J Paediatr Neurol. 2012;16(5):449–458.
